颌面外伤导致颈内动脉钝性损伤继发脑梗死的治疗:8例临床分析  

Study of the treatment strategy of cerebral infarction caused by blunt internal carotid artery injuries resulting from maxillofacial trauma: a report of 8 cases

作　　者：程志华[1] 欧阳火牛[1] 罗聪[1] 郭煜[1] 郭智霖[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院神经外科,上海200011

出　　处：《中国口腔颌面外科杂志》2017年第1期77-79,共3页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的 :探讨重型颌面外伤导致钝性颈内动脉损伤后脑梗死的治疗策略。方法 :回顾性复习2008年1月—2013年12月本院收治的8例颌面外伤引起颈内动脉损伤后脑梗死患者的临床资料。结果:男6例,女2例;年龄19~54岁,平均36±11.95岁;受伤至我院收治时间5~8 h,平均(6.31±1.00)h;伤后均清醒,入院时6例嗜睡,2例昏睡,其中1例次日进展为昏迷,6例偏瘫;8例颌面部CT显示面部骨折,2例合并颅底骨折,1例合并下颌骨骨折;头颅CT发现颈内动脉供血区低密度缺血病灶,无颅内出血。治疗均给予阿司匹林300 mg/d,口服2周,然后改为100 mg,维持6个月,1例行开颅减压手术。6个月后GOS评价,恢复良好6例,轻残1例,重残1例,死亡0例。结论 :颌面骨折合并颈内动脉钝性损伤的患者早期出现缺血导致的中枢神经系统损害表现时,应积极使用抗血小板治疗,以降低卒中引起的病患伤残与死亡率。PURPOSE： To estimate the treatment strategies of cerebral infarction with severe maxillofacial trauma resulting in blunt internal carotid artery injuries（BCAIs）. METHODS： The clinical data of 8 patients with cerebral infarction caused by BCAIs were retrospectively analyzed between January 2008 and December 2013. RESULTS： Of 8patients, 6 were male and 2 were female, aged 19-54 years（mean 36 ±11.95 years）. The time from injury to admission was5-8 hours（mean 6.31 ±1.00 hours）. All patients were awake after injury and presented with neurologic ischemia at admission, 6 cases with drowsiness, 2 cases with semicoma（1 case developed coma one day later） and 6 cases with hemiparalysis. Eight cases with facial fractures were diagnosed by CT scans, and 2 cases with skull base fractures, 1 case with mandible fracture. The ischemic lesions involved in internal carotid artery supply area and no intracranial hemorrhage was identified following head and neck CT scans. All 8 patients received aspirin 300 mg/d for 2 weeks and 100 mg for the following 6 months, and 1 case underwent craniotomy. For GOS scores 6 month after injury, 6 cases had good recovery, 1case was with moderate disability, 1 case was with severe disability and no case died. CONCLUSIONS： The patients with blunt internal carotid artery injuries complicated by maxillofacial fractures should be diagnosed in early stage, and the application of antiplatelet therapy could reduce BCAIs stroke-related morbidity and mortality.

关 键 词：脑梗死 颌面骨折 颈内动脉 钝性损伤 抗血小板治疗 

分 类 号：R782.4[医药卫生—口腔医学]